The Art and Science of Treating HIV

Treating HIV, it has been said, is as much an art as it is a science. There is a certain amount of deftness and skill that your doctor and you must apply in order to achieve lifelong success in combating the virus. In addition to the question of when to start treatment, and what combination of meds to start with, there are a whole host of other considerations that must be taken into account as well. Am I ready to take the medications, as prescribed, every day for the rest of my life? Which treatment is best for me? Do I have other medical conditions that affect how I can take my drugs? Will they fit into my lifestyle? Do I have other problems, such as insufficient housing, inadequate health insurance, or substance abuse issues, which need to be looked at or dealt with first, before beginning treatment? Or are these issues now affecting my ability to remain adherent?

The cover of this year's HIV Drug Guide uses a familiar image, Leonardo da Vinci's "Vitruvian Man." Vitruvius was a first century Roman architect who believed that the measurements and proportions of the human body were divinely created, perfect, and correct, and symbolized the merging of both art and science together.

When we take medications to treat and suppress the virus, we not only are benefiting from the science that has gone into the years of research and development in creating those drugs, but we also gain from the lessons learned, as well as the mistakes made, by the many health care providers who have had years of experience successfully treating their HIV-positive patients. And we then use our own skills and tricks that we have developed over time to help us remember to take our meds at the prescribed time, either with or without food, and at the correct dosage.

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But beware -- don't fall into the trap of letting the art trump the science. I was talking with a friend recently who told me that he was feeling so much better since he recently switched his meds. Side effects were greatly reduced, he told me, and his numbers were vastly improved -- better than they had been in a long time. However, in an effort to reduce the severity of the GI upset he was still experiencing, he had cut the doses of all of his medications in half, and he felt this was a reasonable and equitable compromise.

I tried to explain to my friend that this was not a good idea -- actually a really bad one -- because while doing so might make him feel better in the short term, and his numbers may indeed be okay for a while, he would eventually most likely begin to develop resistance to the medications and they would no longer work, and would possibly limit his other treatment options in the future. I stressed to him the importance of talking to his physician to find out if there were perhaps other meds he could try that would be easier to take, or about ways to reduce the side effects.

And then, sadly, a lot of it ultimately boils down to just plain economics. The Wall Street Journal recently reported that many of the strides in scaling up treatment and advancing prevention efforts which have been made over the last few decades in Uganda are in danger of being lost due to cutbacks in funding from the U.S. A pregnant Ugandan woman with HIV was turned away from clinic after clinic, the article explained, because they simply did not have the capacity to accept any more patients. Other women who are lucky enough to get treatment will often share their pills with friends who aren't as lucky, resulting in none of them taking enough medication to keep the virus suppressed. The end result, of course, is the development of resistance to the medications for all of the women.

But I never give up hope, and am continually inspired by our readers and those who I am privileged to meet through the work that I do. Recently, I was approached by a bright, attractive young man who I had never met, but who called me by name. He said, "Jeff, I just wanted to tell you that your magazine saved my life." I was speechless, and completely caught off guard. He was truly genuine and articulate as he went on to explain that at first he was depressed and didn't know what to do when he learned of his diagnosis, but then picked up a copy of Positively Aware and began reading it. It gave him so much hope, he said, and he realized that he was going to be okay, and would be able to get on with living the rest of his life.

And to me, that is the perfect blend of art and science, while living with HIV.

Be good to yourself, and each other.

With this issue, we bid a fond farewell to our good friend Russell McGonagle, Positively Aware's Art Director for the last 10 years. Russell's amazing vision and artistry has been an integral part of our team, and a key to the continued success of the publication ... we'll miss you, Russell! We welcome PA's new Art Director, Rick Guasco, into the TPAN family.

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